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Difficulty: HardPharmacological Therapies

A client recovering from an ischemic stroke is receiving continuous enteral nutrition via a percutaneous endoscopic gastrostomy (PEG) tube. The client's medication administration record includes scheduled morning doses of extended-release nifedipine and liquid acetaminophen. Which action by the practical nurse demonstrates safe pharmacological practice?

  1. A
    Crush the extended-release nifedipine into a fine powder, dissolve it in 30 mL of sterile water, and administer it via the PEG tube.
  2. Withhold the extended-release nifedipine, administer the liquid acetaminophen, and notify the registered nurse to request an appropriate immediate-release alternative.Answer
  3. C
    Substitute the oral nifedipine with an intravenous push antihypertensive medication to ensure the client receives the scheduled dose on time.
  4. D
    Convert the ordered nifedipine dosage into milligrams per kilogram (mg/kg) to determine if the capsule can be safely divided in half for administration.

Answer

The safe action is to withhold the extended-release nifedipine, administer the liquid acetaminophen, and collaborate with the registered nurse to request a therapeutically equivalent immediate-release or liquid alternative.
Extended-release (ER) medications are formulated to release their active ingredients slowly over an extended period. They must never be crushed, chewed, or opened. Doing so destroys the delayed-release mechanism, causing a rapid absorption of the entire dose at once (dose dumping), which can lead to severe adverse effects such as profound hypotension. Because intact capsules cannot be given via a percutaneous endoscopic gastrostomy tube, the safest action is to withhold the medication, safely administer the liquid acetaminophen, and collaborate with the registered nurse or healthcare provider to obtain a therapeutically equivalent liquid or immediate-release formulation.

Step-by-Step Solution

1
Review the prescribed medication properties against the ordered route of administration.
Nifedipine is prescribed as an extended-release capsule, while acetaminophen is a liquid. The route is a PEG tube, which requires medications to be in liquid form or crushed and dissolved.
To determine if the physical properties of the medications allow for safe administration via the prescribed enteral tube.
2
Analyze the compatibility of extended-release medications with feeding tube administration.
Extended-release formulations cannot be crushed, chewed, or opened without destroying their time-release mechanism.
Crushing an extended-release antihypertensive causes rapid, uncontrolled absorption known as 'dose dumping,' leading to severe systemic toxicity such as profound hypotension.
3
Determine the appropriate nursing intervention within the practical nurse scope of practice.
The practical nurse must safely administer the liquid medication (acetaminophen), withhold the contraindicated extended-release medication (nifedipine), and immediately collaborate with the registered nurse.
To ensure client safety and facilitate securing a viable alternative formulation from the healthcare provider or pharmacist.

Key Concept

Safe Administration of Enteral Tube Medications and Formulation Limitations
Estimated Time:1m 30s
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Topics

Pharmacological Therapies

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